A Comparative Evaluation of Endoscopic Retrograde Cholangiopancreatography and the Secretin-Cholecystokinin Test in the Diagnosis of Chronic Pancreatitis: A Multicentre Study in 124 Patients

Abstract

A comparative evaluation of ERCP and the bicarbonate output 30 min after stimulation of the pancreas with secretin and cholecystokinin-pancreozymin, was carried out in 124 patients, of whom 65 were affected by proven chronic pancreatitis (PCP), and 59 by only suspected chronic pancreatitis (SCP). In PCP patients the false negative results were 14.7% and 21.5%, respectively. In 5 of the PCP patients with false negatives on ERCP and functional test a normal result of both the procedures was found. ERCP and bicarbonate output were found to be abnormal in 12% and 40%, respectively of 59 patients with SCP. In 30 SCP subjects both procedures gave a normal result, and only in two cases were results abnormal. A correct classification of the SCP patients with pathological bicarbonate secretion and normal ERCP seems quite impossible. The diagnostic usefulness of ERCP results is preeminent but the of carrying out both types of investigation together may give complementary information in the evaluation of pancreatic disorders.

Comparison of Endoscopic Ultrasound and Endoscopic Retrograde Pancreatography for the Prediction of Pancreatic Exocrine Insufficiency

“…We acknowledge that direct pancreatic function testing is not a perfect gold standard. For example, some patients with advanced structural changes of chronic pancreatitis may have intact exocrine function [19]. However, the use of PFT allows a fair, simultaneous, and critical comparison of the results of EUS and ERP.…”

Reliable diagnosis of chronic pancreatitis: what is really necessary?

“…Eine genaue Übereinstimmung liegt jedoch nur in 74-86% der Fälle vor (14,27,32,34,37,43). Darüber hinaus gibt es Patienten mit exokriner Pankreasinsuffizienz und normalem Gangsystem (Gruppe 1) und umgekehrt Patienten mit normaler Pankreasfunktion und Pankreasgangveränderungen (Gruppe 2) (15,27).…”

“…der Erkrankung nur mit einer Sensitivität von 0-47% nachgewiesen werden (7,11,13,26 Vergleichende Untersuchungen haben gezeigt, dass bei den meisten Patienten ein Verlust der exokrinen Pankreasfunktion mit Gangveränderungen einhergeht. Eine genaue Übereinstimmung liegt jedoch nur in 74-86% der Fälle vor (14,27,32,34,37,43). Darüber hinaus gibt es Patienten mit exokriner Pankreasinsuffizienz und normalem Gangsystem (Gruppe 1) und umgekehrt Patienten mit normaler Pankreasfunktion und Pankreasgangveränderungen (Gruppe 2) (15,27).…”